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A method is presented to obtain the climatology of extreme wind speeds coincident with the occurrence of rain. The simultaneous occurrence of wind and rain can force water through building wall components such as windows, resulting in building damage and insured loss. To quantify this hazard, extreme value distributions are fit to peak 3-s wind speed data recorded during 1-min intervals with specific reported rain intensities. This improves upon previous attempts to quantify the wind-driven rain hazard that computed wind speed and rainfall-intensity probabilities independently and used hourly data that cannot assure the simultaneous occurrence of peak wind that represents only a several-second interval within the hour and rain that is accumulated over the entire hour. The method is applied across the southeastern United States, where the wind-driven rain hazard is most pronounced. For the lowest rainfall intensities, the computed wind speed extremes agree with published values that ignore rainfall occurrence. Such correspondence is desirable for aligning the rain-intensity-dependent wind speed return periods with established extreme wind statistics. Maximum 50-yr return-period wind speeds in conjunction with rainfall intensities ≥0.254 mm min−1 exceed 45 m s−1 in a swath from Oklahoma to the Gulf Coast and at stations along the immediate Atlantic coast. For rainfall intensities >2.54 mm min−1 maximum, 50-yr return-period wind speeds decrease to 35 m s−1 but occur over a similar area. The methodology is also applied to stations outside the Southeast to demonstrate its applicability for incorporating the wind-driven rain hazard in U.S. building standards. Significance Statement: Rainfall driven horizontally by strong winds can penetrate building components and cladding. If unmanaged, this can directly damage the building and its contents and become a substantial component of insured losses to buildings. A climatology of wind-driven rain is developed from recently available 1-min weather observations that better represent the joint occurrence of the extremes that define wind-driven rain occurrence than hourly data. This work is a first implementation of 1-min data into extreme-value statistical models, providing a basis for including wind-driven rain in United States building codes. This inclusion would be most significant in the hurricane-prone regions of the southeastern United States. The omission of wind-driven rain in U.S. building codes contrasts to its inclusion in Europe and Canada. [ABSTRACT FROM AUTHOR]

Geographic information systems (GIS) are fundamental information technologies. The capabilities and applications of GIS continue to rapidly expand, requiring practitioners to have new skills and competencies, especially in computer science. There is little research, however, about how best to prepare the next generation of GIScientists with adequate computer science skills. This article explores how U.S. geography departments are introducing and developing computer science and programming skills in their geography and GIS degree programs. We review the degree requirements in fifty-five geography departments and discover that forty-four of them offer some kind of GIS programming course. Of the 210 separate degree options identified, however, only 22 require one of these courses for a degree. There is little consistency or emphasis on computer science and programming skills in geography or GIS degrees, despite the immense importance of these components in geography and GIS careers. We propose future research along distinct investigative tracks to build a research-based understanding of the educational interactions among GIS, computer science, programming, and geography. [ABSTRACT FROM PUBLISHER]

The deployment of ruggedized surface observing platforms by university research programs in the path of landfalling tropical cyclones has yielded a wealth of information regarding the near-surface wind flow characteristics. Data records collected by Texas Tech University's Wind Engineering Mobile Instrument Tower Experiment and StickNet probes and by the Florida Coastal Monitoring Program along the Gulf Coast of the United States from 2004 to 2008 were compiled to examine influences on near-surface gust factors. Archived composite reflectivity data from coastal WSR-88D instruments were also merged with the tower records to investigate the influence of precipitation structure. Wind records were partitioned into 10-min segments, and the ratio of the peak moving-average 3-s-gust wind speed to the segment mean was used to define a gust factor. Observations were objectively stratified into terrain exposure categories to determine if factors beyond those associated with surface frictional effects can be extracted from the observations. Wind flow characteristics within exposure classes were weakly influenced by storm-relative position and precipitation structure. Eyewall observations showed little difference in mean gust factors when compared with other regions. In convective precipitation, only peak gust factors were slightly larger than those found in stratiform conditions, with little differences in the mean. Gust factors decreased slightly with decreasing radial distance in rougher terrain exposures and did not respond to radar-observed changes in precipitation structure. In two limited comparisons, near-surface gusts did not exceed the magnitude of the wind maximum aloft detected through wind profiles that were derived from WSR-88D velocity-azimuth displays. [ABSTRACT FROM AUTHOR]

Current design loads for roofing tile systems in the U.S. are determined based on a standardized wind tunnel testing method developed in the 1990s to examine wind-induced pressures on the upper and lower surfaces of the tile. The method neglects several key parameters that are well known to affect wind loading (e.g. wind angle, specimen shape, etc.). The research objective of this study is to investigate this method by [1] characterizing wind-induced surface pressure distributions on field tiles for varying wind angles of attack and [2] measuring load path intensity through mechanically fastened tile attachments. Surface pressure distributions were measured on three full-size, rapid prototyped roofing tile models with 256 pressure taps immersed in wind flows. The models are geometrically identical to low-, medium- and high-profile concrete roofing tiles that are widely used in high wind areas. Additionally, their real counterparts were instrumented with load cells to measure reaction forces at mechanical fasteners. The results highlight areas of the method that are lacking in specificity and shows that low-resolution pressure measurement may yield conservative parameters for low- and medium-profile tiles but is potentially not conservative for asymmetric (s-shaped) high-profile tiles. [ABSTRACT FROM AUTHOR]

Abstract: Detailed observations from surface layer experiments in the path of Atlantic hurricanes are presented in this paper. The purpose is to obtain information that will aid in the reduction of hurricane wind damage to residential structures by providing input for wind tunnel and full-scale flow simulation experiments that assess wind loads on these structures under hurricane conditions. The contents of the paper document the mean flow and turbulence characteristics from data recorded by nine mobile instrumented towers deployed at coastal locations near the anticipated path of each of the three hurricanes (Katrina, Rita, and Wilma) that made landfall on the US coast along the Gulf of Mexico in 2005. Wind data were collected at two elevations (5 and 10m) from these towers by the Florida Coastal Monitoring Program, a joint research program led by the University of Florida and the Institute for Business and Home Safety. [Copyright &y& Elsevier]

Recent articles by Dear and Flusty, Logan, Marcuse and Nijmann have initiated a debate regarding the characteristics of modern and post-modern urbanism. One of the differences between the two, it is contended, is in their residential geographies: post-modern cities, it is argued, are more heterogeneous and fragmented than modern cities, which are characterized by extreme segregation of ethnic groups into citadels (the host society) and enclaves/ghettos (all other groups). Testing these ideas empirically requires a methodology which allows rigorous comparisons over space and time. This article uses a recently-developed comparative methodology to explore differences in their residential patterns between two modern (Chicago and New York) and two post-modern (Los Angeles and Miami) US cities, using data on the four main ethnic groups from the initial Census 2000 releases. It shows very clear differences between the two pairs, in the expected directions, but also differences within pairs – especially the two post-modern cities. [Copyright &y& Elsevier]

Although research on reproductive behavior depends heavily on information from surveys, abortions are characteristically underreported in such data. Estimates of the level of reporting are made for each of the recent major surveys of U.S. women: the 1976, 1982, and 1988 cycles of the National Survey of Family Growth, the 1976 and 1979 National Surveys of Young Women, and the National Longitudinal Surveys of Work Experience of Youth. The estimates are based on comparisons with external counts of abortions taking place. We examine variation by characteristics of women, trends over time, and the possible effects of length of recall and of the way in which questions about abortion are asked. Abortion reporting is found to be highly deficient in all the surveys, although the level varies widely. Whites are more likely to report their abortions than nonwhites. Special, confidential questioning procedures hold promise for improving the results. [ABSTRACT FROM AUTHOR]

Describes a case of clinical cholera in a U.S. physician and his serologic response to cholera vaccine and the illness. Medical profile of the patient; Symptoms manifested by the physician; Results of serologic tests conducted on the patient.

Focuses on the difficulties experienced by students of endodontics in comparing notes of lectures attended in Europe and in the U.S. Goal of the Social Welfare Health-Service; Main simplified systems offered in Europe; Differences in the techniques.

Increasing the therapeutic potential and reducing the side effects of U.S. Food and Drug Administration-approved glucagon-like peptide-1 receptor (GLP-1R) agonists used to treat obesity require complete characterization of the central mechanisms that mediate both the food intake-suppressive and illness-like effects of GLP-1R signaling. Our studies, in the rat, demonstrate that GLP-1Rs in the locus coeruleus (LC) are pharmacologically and physiologically relevant for food intake control. Furthermore, agonism of LC GLP-1Rs induces illness-like behaviors, and antagonism of LC GLP-1Rs can attenuate GLP-1R-mediated nausea. Electrophysiological and behavioral pharmacology data support a role for LC GLP-1Rs expressed on presynaptic glutamatergic terminals in the control of feeding and malaise. Collectively, our work establishes the LC as a site of action for GLP-1 signaling and extends our understanding of the GLP-1 signaling mechanism necessary for the development of improved obesity pharmacotherapies.

Objective: To advance the science of cognitive outcome measurement for individuals with intellectual disability (ID), we established administration guidelines and evaluated the psychometric properties of the NIH-Toolbox Cognitive Battery (NIHTB-CB) for use in clinical research., Methods: We assessed feasibility, test-retest reliability, and convergent validity of the NIHTB-CB (measuring executive function, processing speed, memory, and language) by assessing 242 individuals with fragile X syndrome (FXS), Down syndrome (DS), and other ID, ages 6 through 25 years, with retesting completed after 1 month. To facilitate accessibility and measurement accuracy, we developed accommodations and standard assessment guidelines, documented in an e-manual. Finally, we assessed the sensitivity of the battery to expected syndrome-specific cognitive phenotypes., Results: Above a mental age of 5.0 years, all tests had excellent feasibility. More varied feasibility across tests was seen between mental ages of 3 and 4 years. Reliability and convergent validity ranged from moderate to strong. Each test and the Crystallized and Fluid Composite scores correlated moderately to strongly with IQ, and the Crystallized Composite had modest correlations with adaptive behavior. The NIHTB-CB showed known-groups validity by detecting expected executive function deficits in FXS and a receptive language deficit in DS., Conclusion: The NIHTB-CB is a reliable and valid test battery for children and young adults with ID with a mental age of ≈5 years and above. Adaptations for very low-functioning or younger children with ID are needed for some subtests to expand the developmental range of the battery. Studies examining sensitivity to developmental and treatment changes are now warranted., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda., Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors., Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions., Conclusion: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals., (© 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Our primary objective was to study postprocedural outcomes and hospitalization costs after peripheral endovascular interventions and the multivariate predictors affecting the outcomes with emphasis on hospital volume. The study cohort was derived from Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (2006 to 2011). Peripheral endovascular interventions were identified using appropriate International Classification of Diseases, Ninth Revision diagnostic and procedural codes. Annual institutional volumes were calculated using unique identification numbers and then divided into quartiles. Two-level hierarchical multivariate mixed models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and postprocedural complications. Amputation rates and hospitalization costs were also assessed. Multivariate analysis (odds ratio, 95% confidence interval, p value) revealed age (1.46, 1.37 to 1.55, p <0.001), female gender (1.28, 1.12 to 1.46, p <0.001), baseline co-morbidity status as depicted by a greater Charlson co-morbidity index score (≥2: 4.32, 3.45 to 5.40, p <0.001), emergent or urgent admissions(2.48, 2.14 to 2.88, p <0.001), and weekend admissions (1.53, 1.26 to 1.86, p <0.001) to be significant predictors of primary outcome. An increasing hospital volume quartile was independently predictive of improved primary (0.65, 0.52 to 0.82, p <0.001 for the fourth quartile) and secondary (0.85, 0.73 to 0.97, 0.02 for the fourth quartile) outcomes and lower amputation rates (0.52, 0.45 to 0.61, p <0.001). A significant reduction hospitalization costs ($-3,889, -5,318 to -2,459, p <0.001) was also seen in high volume centers. In conclusion, a greater hospital procedural volume is associated with superior outcomes after peripheral endovascular interventions in terms of inhospital mortality, complications, and hospitalization costs., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To examine the impact of the first nurse-implemented tele-intensive care unit (tele-ICU) staffing model, with the intent that shared nursing vigilance and collaboration can decrease patient complications potentially impacting patient outcomes., Subjects and Materials: A quantitative study used a pre-post program design of 90 staff nurses in the Adult Critical Care Unit, 10 tele-ICU nurses, and 1,308 patient participants at Providence Alaska Medical Center (Anchorage, AK). Twelve months of baseline data were collected: Acute Physiology and Chronic Health Evaluation severity-adjusted ICU length of stay (LOS), ICU mortality, protocols for the prevention of ventilator-associated pneumonia (VAP), ventilator bundle compliance (stress ulcer and venous thrombosis prophylaxis), and glucose control. Follow-up data were obtained using the same outcomes examined for baseline: 9 months for the nurse and only an additional 3 months with the addition of physician monitoring services., Results: Data demonstrated post-tele-ICU implementation improvements as follows: severity-adjusted LOS decrease, 15% (222 patient-days saved); severity-adjusted ICU mortality decrease, 14% (20 lives saved); compliance improvement of "at-risk" patients, restraint documentation 26% improvement; ventilator bundle compliance, 6% increase; and VAP, 13% decrease in patient-days., Conclusions: Collaboration between bedside and remote nurses in conjunction with the use of tele-ICU program technology positively impacts critical care patient outcomes. Effective nursing collaboration and communication and improved patient outcomes can be attained through nursing vigilance and attention to best practices or health system protocols and the use of smart technology such as the population management tools in the tele-ICU program.

An evidence-based approach may decrease variations in practice and time delays in adopting new procedures. This report describes the process for incorporating evidence-based decision making (EBDM) into curricula using active teaching techniques. The process centers on a national four-day Faculty Development Institute (FDI) program for dental hygiene, occupational therapy, and physical therapy faculty. Phase I assesses pre-Institute EBDM knowledge, skills, and teaching strategies. Phase II, onsite, involves learning EBDM principles and teaching skills and developing an educational package. Phase III integrates these into the curriculum, with ongoing follow-up. At baseline, faculty were unfamiliar with EBDM but were incorporating related skills. Formulation of questions and evidence gathering for patient-care decisions were weak. Phase II follow-up showed a significant increase in EBDM knowledge, p < 0.001, and 100% agreed or strongly agreed that they were prepared to integrate EBDM into their courses; 93% felt better prepared to use EBDM. Curricula and educational experiences need to include EBDM skills. The three-phase process can support faculty in making needed changes.

Background: Because U.S. dental hygienists play a significant role in providing prevention and early-detection services, it is important to describe and evaluate their oral cancer knowledge and opinions., Methods: A pretested survey, cover letter, and prepaid return envelope were mailed to 960 dental hygienists, followed by three complete follow-up mailings., Results: The respondents were not as knowledgeable about oral cancer risk factors and diagnostic procedures as hypothesized. Although the respondents were well informed about certain key aspects of oral cancer risk factors and diagnostic procedures, there were many aspects of these topics in which they were deficient and in some cases misinformed., Conclusions: Dental hygiene curricula should be updated and continuing education coursesabout oral cancer should be developed and implemented.

Accurate price signals are essential for producers of American lamb to ensure production of uniformly lean animals. Development of carcass merit-pricing systems will require the use of objective technology for assessing carcass composition or lean distribution. The objective of this study was to evaluate electronic technologies for accurate determination of lamb carcass composition. Lambs (n = 106) were selected as a representation of U.S. market lambs that transcended geographic location, sex, breed, carcass weight, yield grade, and production system. The independent variables used to predict lamb composition varied with the technology. The electronic technologies tested included realtime ultrasound, optical reflectance probe, bioelectrical impedance analysis, and electromagnetic scanning (TOBEC). All technologies, except realtime ultrasound, were tested on warm (prerigor) carcasses and repeated after a 24-h chill. Longitudinal ultrasonic scans of fat and muscle tissue depth and grading probe fat depths were marginal predictors of proportional carcass yield. The TOBEC measurements often accounted for more variability associated with kilograms of dissected lean and percentage of carcass lean than did carcass weight. Equations from TOBEC measurements were the most accurate predictors of weight and percentage of dissected and fat-free lean. Bioelectrical impedance measurements of resistance and reactance combined with carcass weight were also good predictors of carcass composition. Prediction of carcass lean distribution by measures of TOBEC were the most accurate for prediction of leg lean. The implications of usefulness of these technologies will depend on the commitment of the U. S. sheep industry in development of a lamb price discovery system based on carcass composition.

Results of a 1995 survey reveal that 1,437 local health departments-half of those in the country-provide sexually transmitted disease (STD) services and receive about two million client visits each year. Their clients are predominantly individuals with incomes of less than 250% of the poverty level (83%), women (60%) and non-Hispanic whites or blacks (55% and 35%, respectively); 36% of clients are younger than 20, and 30% are aged 20-24. On average, 23% of clients tested for STDs have chlamydia, 13% have gonorrhea, 3% have early-stage syphilis, 18% have some other STD and 43% have no STD. Virtually all public STD programs offer testing and treatment for gonorrhea and syphilis; only 82% test for chlamydia, but 97% provide treatment for it. Some 14% offer services only in sessions dedicated to STD care, 37% always integrate STD and other services, such as family planning, in the same clinic sessions, and 49% offer both separate and integrated sessions. STD programs that integrate services with other health care typically cover nonmetropolitan areas, have small caseloads, serve mainly women and provide a variety of contraceptives. In contrast, those that offer services only in dedicated sessions generally are in metropolitan areas and have large caseloads; most of their clients are men, and few provide contraceptive methods other than the male condom.

Private physicians provide family planning services to the majority of American women. According to data from the National Ambulatory Medical Care Survey, office-based physicians received on average 13.5 million visits annually for contraceptive services during 1990-1992. Private insurance was the expected from of payment for 38% of visits, while managed care covered 22% of visits, and Medicaid or another source of public assistance subsidized 12%; 22% were self-paid and 6% covered by other sources. The majority of patients who received contraceptive services gave a reason other than general family planning or care regarding a specific contraceptive as the primary purpose for their visit, although women covered by a managed care plan or through public funding were the most likely to give general family planning needs as the main reason. Women whose visit was listed as publicly funded were less likely to have a contraceptive prescribed or provided or to obtain a Pap test than were those expected to pay with private insurance.

One in every six U.S. birth certificates have no information on the age of the baby's father; for more than four in 10 babies born to adolescent women, no data are available on the father's age. Information from mothers aged 15-49 who had babies in 1988 and were surveyed in the National Maternal and Infant Health Survey indicates that fathers for whom age is not reported on the birth certificate are considerably younger than other fathers. In 1988, 5% of fathers were under age 20, and 20% were aged 20-24. Fathers typically are older than mothers, especially when the mothers are teenagers. Fathers who are unmarried, black or partners of lower income women are younger than other fathers.

Carcasses of 154 hogs representing seven genotypes with substantial variation in carcass composition and percentage of lean were completely dissected and analyzed. Measurements from a ruler, Hennessy probe, and electromagnetic scanner were each used to predict wholesale and lean boneless carcass value. Error, defined as dissected value minus predicted value, due to the omission of sex, genotype, weight, and their interactions was estimated for each model. The errors were significantly different from zero for the models using ruler and electromagnetic scanning measurements separately (P < .01). Errors due to sex, genotype, weight, and their interactions were greatest for the less lean barrows. A combination of probe and electromagnetic scanner measurements resulted in the least error. The value of barrows with low percentage of lean was consistently overpredicted, whereas the value of leaner gilts was underpredicted for the models using ruler and electromagnetic scanning separately (P < .001).

Dissected and predicted wholesale and lean boneless values for 154 pork carcasses representing seven genotypes with substantial variation in carcass composition and percentage of lean were determined. Dissected carcass value was determined using a component pricing model, and four alternative models were specified to predict that value. The models included measurements from a ruler (RULER) and two carcass evaluation technologies, Hennessy probe (PROBE) and electromagnetic scanner (EMS1). A combination of the PROBE and EMS1 models (EMS2) was also used. For wholesale value, R2 were .40, .70, .59, and .74, and the RSD were 8.18, 5.77, 6.76, and 5.38 ($/100 kg of carcass value) for RULER, PROBE, EMS1, and EMS2, respectively. For lean boneless value, the R2 were .41, .73, .59, and .74, and the RSD were 8.34, 5.67, 6.99, and 5.51 ($/100 kg of carcass value) for RULER, PROBE, EMS1, and EMS2, respectively. The results indicate that a combination of probe and electromagnetic scanner measurements provided the best fit to dissected value.

The National Maternal and Infant Health Survey provides new data on the prevalence of unintended childbearing in the United States: Thirty-six percent of births in 1988 were mistimed and 7% were unwanted, while 57% were intended. Although the level of unintended childbearing is high in almost all socioeconomic subgroups of women, the proportion of births that were mistimed or unwanted was 50% or more among age-groups 15-17 (78%), 18-19 (68%) and 20-24 (50%), and among never-married women (73%), formerly married women (62%), black women (66%), women living below the federal poverty level (64%) or at 100-149% of the poverty level (52%), women with less than 12 years of education (58%) and women who already had two children (53%) or three or more children (60%). Multivariate analyses indicate that births to unmarried women--whether formerly married or never-married--are less likely than those to married women to be wanted and more likely to be mistimed. Poverty status has no independent effect on the odds that a birth is unwanted or on the odds that a birth to an unmarried woman is mistimed. Among currently married women, those who are poorer are more likely than women above 150% of the poverty level to have a mistimed birth. Black women are more likely than either Hispanic or white women to report a birth as unwanted and are more likely than white women to say a wanted birth was mistimed.

Women aged 15-44 rate the pill, the condom, vasectomy and female sterilization most highly, according to 1992 data from an annual survey by Ortho Pharmaceutical Corporation of contraceptive attitudes and method use. The 6,955 survey respondents underrepresent women who are black or who have household annual incomes greater than $50,000, but they are similar to all American women in age, marital status and region of the country. About 74-84% of women giving an opinion view these methods favorably and 64% rate the hormonal implant favorably. The proportion of unmarried women who had had intercourse increased from 76% in 1987 to 86% in 1992. As a result, proportions of women at risk of unintended pregnancy rose from 72% to 77%. Contraceptive use also rose, from 92% to 94%. The most commonly used method is the pill (39%), followed by the condom (25%), female sterilization (19%) and vasectomy (12%). Married women exposed to the risk of unintended pregnancy are more likely to use sterilization (48%), while unmarried women are more likely to use the pill (52%) and the condom (33%). Pill use has increased since 1987, especially among married women, and condom use has increased among all women. Among unmarried women at risk of unintended pregnancy, condom use rose from 18% in 1987 to 33% in 1992. Among condom users, 40% of unmarried users and 13% of married users also use another method.

Despite the need for more safe and effective contraceptive drugs and devices, enormous barriers to contraceptive research and development have been raised in the United States. The designation of contraceptives as orphan drugs, with concomitant incentives, may be warranted to encourage private manufacturers to reenter the field.

Analysis of data from the 1988 National Survey of Family Growth--corrected for the underreporting of abortion--reveals that contraceptive failure during the first year of use remains a serious problem in the United States, contributing substantially to unintended pregnancy. The pill continues to be the most effective reversible method for which data were available (8% of users accidentally became pregnant during the first year of use), followed by the condom (15%). Periodic abstinence is the method most likely to fail (26%), but accidental pregnancy is also relatively common among women using spermicides (25%). Failure rates vary more by user characteristics such as age, marital status and poverty status than by method, suggesting the extent to which failure results from improper and irregular use rather than from the inherent limitations of the method.

From 1977 to 1988, an epidemic of antiabortion violence took place in the United States, involving 110 cases of arson, firebombing, or bombing. The epidemic peaked in 1984, when there were 29 attacks. Nearly all sites (98%) were clinics that provided abortions. Facilities in 28 states and the District of Columbia were involved. The national rate of violence was 3.7 per 100 abortion providers and 7.2 per 100 nonhospital abortion providers. The national ratio of violence per 100,000 abortions performed was 0.6 Arson was both the most frequent (39% of all cases) and the most damaging (mean cost $141,000) type of violence. The epidemic appears partially attributable to multiple point-source outbreaks of violence caused by small numbers of individuals or groups. Thirty-three persons have been convicted to date. Vigorous prosecution of perpetrators and the reemergence of clinics after damage probably helped to curb the epidemic.

Comparison of 1988 data from the National Survey of Family Growth with 1982 data reveals that the proportion of U.S. women who have had sexual intercourse rose slightly, from 86 percent to 89 percent. Among teenagers, the proportion sexually active rose from 47 percent to 53 percent; most of the change is attributable to increases occurring among white and nonpoor teenagers, thus narrowing racial and income differences. Among women aged 15-44 in 1988 who have ever had intercourse, 67 percent reported that they had had two or more sexual partners in their lifetime. The proportion was highest among women aged 20-34 (about 70 percent), but 58 percent of sexually active teenage women reported having had two or more sexual partners. About 67 percent of women of reproductive age in 1988 were exposed to the risk of unintended pregnancy, up from 63 percent in 1982. Among these women, 35 percent rely on contraceptive sterilization to prevent pregnancy and 55 percent use reversible methods, while 10 percent use no method. Poor women are much more likely than nonpoor women to be using no method of contraception (15 vs. eight percent); among poor teenagers, this proportion reaches 25 percent. The level of contraceptive use at first intercourse among teenage women improved substantially between 1982 and 1988, however, rising from 48 percent to 65 percent. During 1984-1988, almost four in 10 births and almost six in 10 pregnancies among American women were unintended; most of these were mistimed, but 12 percent of births were unwanted ever.(ABSTRACT TRUNCATED AT 250 WORDS)

A methodology previously used to calculate the number of unintended pregnancies averted nationally through publicly funded contraceptive services has been adapted for a state-level analysis in California. An estimated 136,800 unintended pregnancies--which would result in approximately 36,000 births, 85,100 abortions and 15,700 miscarriages--are averted each year because publicly funded contraceptive care is available from clinics and private physicians in California. Federal and state expenditures of $46 million for contraceptive services in California in FY 1989 resulted in an estimated savings of $232-$509 million in public costs for abortions, for prenatal and maternity care and for medical care, welfare and supplementary nutritional programs during the first two years after a birth. These savings represent an average of $7.70 saved for each dollar spent to provide contraceptive services. This savings/cost ratio is 75 percent higher than that previously estimated for the United States as a whole.

A prospective randomized clinical trial of enflurane, fentanyl, halothane, and isoflurane is described. The 17,201 patients were stratified into two groups (preanesthetic medication and no preanesthetic medication) and were randomized to one of four study agents: enflurane, fentanyl, halothane, and isoflurane. Fifteen university-affiliated hospitals in the United States and Canada participated. All patients were first assessed preoperatively. Data were collected during anesthesia, in the immediate recovery period, and for up to 7 days after anesthesia/surgery. The mean age of the patients was 43 yr, the mean height 167 cm, and the mean weight 68 kg. Sixty-five percent of patients were female. In this study 90.7% of patients were classified as ASA Physical Status 1 or 2, and 34.7% of patients smoked. It is concluded that pooling of data across institutions was valid and does allow determination of the efficacy and relative safety of the four study agents.

A prospective, stratified, randomized clinical trial of the safety and efficacy of four general anesthetic agents (enflurane, fentanyl, halothane, and isoflurane) was conducted in 17,201 patients (study population). Patients were studied before, during, and after anesthesia for up to 7 days. Nineteen patients died (0.11%), and in seven of these (0.04%) the anesthetic may have been a contributing factor. The rates of death, myocardial infarction, and stroke in the study population were so low (less than 0.15%) that no conclusions regarding the relative rates of these outcomes among the four anesthetic agents could be reached. The rates of 16 of 66 types of adverse outcomes in the study population were significantly different among the four study agents. Most of these outcomes were minor. However, severe ventricular arrhythmia (P less than 10(-6)) was more common with halothane, severe hypertension (P less than 10(-6)) and severe bronchospasm (P = 0.028) were more common with fentanyl, and severe tachycardia (P = 0.001) was more common with isoflurane. Recovery from anesthesia during the first 30 min was slowest in those patients who received halothane (P less than or equal to 0.001). In addition, patients who received fentanyl experienced less pain during the first hour in the recovery room (P less than 10(-6)). In conclusion, clinically important differences do exist for some outcomes among the four study agents.

Almost one in four U.S. women who use a reversible method of contraception rely on a publicly funded source of care, either a family planning clinic or a private physician reimbursed by Medicaid. According to three scenarios of alternative contraceptive use patterns, if publicly funded services were not available, these women would have between 1.2 million and 2.1 million unintended pregnancies over one year--substantially more than the approximately 400,000 they currently experience. If these women relying on publicly funded services were using no method of contraception, they would be expected to have more than 3.5 million unintended pregnancies in one year. In FY 1987, federal and state governments spent $412 million on contraceptive services for women who otherwise might not have been able to obtain them. If these services had not been available, the additional public costs for medical care, welfare and supplementary nutritional programs during the first two years after a birth or for publicly funded abortions would have totaled $1.2-$2.6 billion. These savings represent an average of $4.40 saved for every dollar of public funds spent to provide contraceptive services.

Between 1982 and 1987, favorable opinion of the pill increased steadily among American women (from 65 to 76 percent), and favorable opinion of the condom rose sharply (from 38 to 60 percent). Approval of the IUD dropped during the period (from 26 percent to 19 percent). During the five years, the proportion of married women aged 18-44 who were exposed to the risk of unintended pregnancy remained the same (78 percent), but the proportion among unmarried women rose significantly (from 64 percent to 69 percent). This change was primarily the result of an increase--from 68 percent to 76 percent--in the proportion of never-married women who had ever had intercourse. The overall level of contraceptive use among 18-44-year-olds who were exposed to risk remained stable over the period, at about 93 percent, but use of the most effective methods (sterilization, pill and IUD) went up, from 68 percent to 71 percent. All of the net increase in effective-method use, however, was limited to married women, among whom reliance on both sterilization and the pill increased (from 46 to 51 percent and from 17 to 22 percent, respectively). Pill use also rose among unmarried women (from 43 to 48 percent), but there was no change in the level of sterilization. The prevalence of IUD use declined among both married and unmarried women (to three percent in each case). Condom use remained steady among married women, at about 15 percent, but among the unmarried it increased markedly, from nine to 16 percent.(ABSTRACT TRUNCATED AT 250 WORDS)

In 1984 and 1985, the number of abortions, the abortion rate and the abortion ratio stayed at approximately the same levels as in the previous three years. Just under 1.6 million abortions were performed, about three percent of women of reproductive age obtained an abortion, and about 30 percent of pregnancies (excluding those ending in stillbirths and miscarriages) were terminated by abortion. However, the number of abortion providers declined by five percent between 1982 and 1985, and the geographic distribution of abortion services continued to be markedly uneven. Eighty-two percent of all U.S. counties--50 percent of those classified as metropolitan and 91 percent of those classified as nonmetropolitan--lacked an abortion provider in 1985. The long-term trend away from hospital abortions persisted during the period: Eighty-seven percent of the abortions performed in 1985 were done in nonhospital facilities, an increase of five percentage points over the 1982 level. Although abortion clinics constituted only 15 percent of all providers, they were responsible for 60 percent of the procedures performed in 1985. Among all abortion facilities, only 43 percent provided services to women after the 12th week of pregnancy. Abortion clinics were far more likely to offer second-trimester procedures than were other types of abortion providers (75 percent, compared with 13-50 percent). As of mid-1986, charges for a first-trimester nonhospital abortion ranged from $75 to nearly $900. The average amount paid was $213. In 1985, only 39 percent of nonhospital abortion facilities accepted state reimbursement for abortions provided to low-income women, and only 55 percent of facilities offered some reduction in charges to such women.

It is estimated that only about half of all abortions occurring during the period covered by the 1982 National Survey of Family Growth were actually reported in the survey; thus, contraceptive failure rates calculated from these data are almost certainly inaccurate. An attempt to correct for the underreporting of abortion indicates that actual 12-month use-failure rates are more than one-third higher than those calculated without taking abortion underreporting into account, with rates ranging from six percent for the pill to 14-16 percent for the condom, diaphragm and rhythm and to 26 percent for spermicides. Patterns of contraceptive failure are similar to those found in earlier studies.

Almost five million women were enrolled in family planning clinics in the United States in 1983, eight percent more than in 1981. The number of family planning provider agencies declined slightly, from 2,504 to 2,462, but the number of clinic sites that could be identified increased slightly, from 5,124 to 5,174. Family planning clinics operate in three-quarters of U.S. counties; in 1975, the last time county coverage was checked, four-fifths of the counties had clinics. About one in 20 women who are exposed to the risk of unintended pregnancy and live in unserved counties are teenagers or low-income women. Nonmetropolitan counties are more likely to be without clinics than are metropolitan counties. Overall, there are 417,000 low-income women and 249,000 teenagers at risk of unintended pregnancy living in counties where there are no family planning clinics. In 1983, health departments constituted six in 10 of all family planning agencies and served two-fifths of all family planning clinic patients; Planned Parenthood affiliates accounted for fewer than one in 10 agencies and served more than one-quarter of all patients. Hospitals and all other agencies served about one-third of the total 1983 caseload. These patterns were similar to those reported for 1981. Family planning clinics continue to serve primarily low-income women: Four-fifths of the nearly five million clinic patients in 1983 had family incomes below 150 percent of the federally defined poverty level. About 1.6 million women aged 19 and younger were served, representing one-third of all clinic patients in 1983.(ABSTRACT TRUNCATED AT 250 WORDS)